Increasing Diversity in Plastic Surgery

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Diversity is vital to people-centered industries, including the practice of medicine. Studies have found that patients trust and ultimately report better outcomes to physicians with whom they identify, usually by race, background, or socioeconomic status.1 In short, patients seek out empathic physicians. However, racial and ethnic minorities such as African Americans and Hispanics are underrepresented in medicine: despite constituting 26 percent of the U.S. population, they represent 6 percent of physicians according to Association of American Medical Colleges data. Although academic plastic and reconstructive surgery has a higher-than-average minority representation (approximately 12 percent),2 much ground has to be covered to establish a representative surgeon population. This will gain importance in the coming decades, as the U.S. Census Bureau predicts that groups currently considered in the minority will constitute a majority of the U.S. population by 2050.3
Increased diversity in the physician workforce can convey numerous benefits. It may help reduce health disparities in vulnerable and underserved populations. It can improve minority participation in clinical trials. (Participants in plastic surgery clinical trials are disproportionately white,4 a phenomenon that may be attributable in part to racial disagreement between providers/researchers and participants.) Diverse medical institutions have been shown to graduate students with increased performance, increased cultural competency, and improved ability to care for diverse patient populations.5
Despite these findings and commitments by many medical institutions, the physician population does not yet represent that of the United States.6 Plastic surgeons constitute a racially disproportionate workforce compared with other medical specialties.2 New initiatives leading to understanding reasons for lack of diversity, promoting dialogue among involved groups, and creating educational opportunities for minority students have benefited specialties such as internal medicine. Recently, medical institutions have prioritized inclusion through education, resulting in a more diverse generation of doctors. It is vital that medicine continue this progress. However, many efforts fail to account for the complexity of diversity, limiting the definition primarily to race and ethnicity when it encompasses much more.
Institutions such as The Johns Hopkins University define identity as multifaceted, using a concept called the Wheel of Diversity.7 The premise is that people have various aspects contributing to their identities and values: age, sex, socioeconomic status, physical ability, sexual orientation, and more. Our department uses these principles to select our residents and faculty members to establish a diverse workforce.
True diversity goes beyond race and ethnicity. Unfortunately, “diversity” has been simplified to make its quantification easier, as previous research using limited definitions has shown. Although an acceptable starting point, additional efforts should be made to continue expanding data documenting differing facets of the human experience, and to study their impact on the physician workforce and the patients served.
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